Necrotizing Periodontal Diseases Overview

Necrotizing Periodontal Diseases

• Necrotizing periodontal diseases (NPD) are a severe group of oral conditions characterized by tissue destruction.
• NPD prevalence is low, yet crucial due to rapid tissue damage.
• NPD is often associated with severe conditions in patients with dental biofilm.

Necrotizing Ulcerative Gingivitis (NUG)

• NUG is an acute infection affecting the marginal gingiva.
• NUG is characterized by white/grey slough of necrotic tissue.
• Adjacent tissue exhibits redness and inflammation.
• Necrotic areas start at papillae tips, forming punched-out ulcers.
• Bacteria involved, like spirochaetes, Borrelia vincenti, and Fusobacterium, vary among patients and sites.

Predisposing Factors for NPD

• Pre-existing gingivitis
• Poor oral hygiene (OH)
• Smoking
• Stress
• Weakened immune system (e.g., in HIV patients)

Signs and Symptoms of NUG

• Ulceration of gingiva (especially papillae tips).
• Formation of a pseudo-membrane (a thin film of dead tissue).
• Pain
• Strong, distinct bad breath (halitosis).

Treatment of NUG

• Debridement (removing dead tissue).
• Appropriate mouthwashes (e.g., chlorhexidine, hydrogen peroxide).
• Possible antibiotic therapy (e.g., metronidazole) for the acute phase.
• Identifying and addressing predisposing factors to prevent recurrence.

Necrotizing Ulcerative Periodontitis (NUP)

• NUP is a potentially severe progression of NUG.
• NUP is characterized by necrosis of the periodontal ligament and alveolar bone.
• NUP lesions are sometimes observed in patients using recreational drugs.
• The condition can extend beyond 10mm past the gingival margins.
• Certain forms of NPD, like Noma, can follow NUP in specific populations.

Case Study: Gladys

• Gladys, born in 1988, was diagnosed with necrotizing periodontitis in 2006.
• Gladys was a young adult with a history of perinatally acquired HIV infection, with a variety of HIV-related diseases and a multi-drug-resistant virus.
• Gladys exhibited various medical complications alongside her periodontal condition. (e.g., pulmonary TB, oral candidiasis).
• Gladys had been suffering from worsening gum infection for several months before diagnosis.
• Several treatments, including medications like HAART, were administered to manage her symptoms.

Management of Gladys's Case

• Medical team conducted a comprehensive evaluation including photographs.
• Gladys's medication regimen was adjusted, including metronidazole.
• Ointments and mouthwashes were prescribed.
• Extensive debridement procedures were prioritized at a specific clinic.
• Gladys's detailed condition was monitored during this process.

Conclusion on NPD

• NUG is easily recognized–“once seen and smelled it is never forgotten.”
• NUG usually occurs on top of pre-existing oral disease.
• Patients are prone to recurrence if oral hygiene is not maintained diligently.
• NUP is a rare condition and requires specialized treatment.